What are the uses and precautions of scopolamine (anticholinergic medication)?

From the Guidelines

Scopolamine is primarily used to prevent motion sickness and should be used with caution due to its anticholinergic side effects, particularly in elderly patients. The medication works by blocking muscarinic acetylcholine receptors in the central and peripheral nervous system, which helps prevent nausea signals from reaching the vomiting center in the brain and reduces secretions and smooth muscle spasms 1.

Uses of Scopolamine

• Prevention of motion sickness: a transdermal patch (1.5mg) applied behind the ear 4 hours before travel, effective for up to 72 hours
• Treatment of postoperative nausea and vomiting: can be given as an injection (0.3-0.6mg) or as the patch
• Management of symptoms of irritable bowel syndrome
• Utilized in ophthalmology to dilate pupils and in anesthesia as a premedication to reduce secretions

Precautions and Side Effects

• Important precautions include avoiding use in patients with glaucoma, urinary retention, gastrointestinal obstruction, or myasthenia gravis, as scopolamine can worsen these conditions
• Common side effects include dry mouth, blurred vision, drowsiness, and confusion
• Elderly patients are particularly susceptible to anticholinergic side effects and should use reduced doses
• Patients should wash hands thoroughly after handling patches to avoid transferring medication to the eyes, which could cause temporary pupil dilation and blurred vision

Additional Considerations

• Scopolamine can also be used to reduce excessive secretions associated with dyspnea, but its use should be carefully considered due to its potential side effects 1
• The onset of benefit for transdermal scopolamine patches is about 12 hours, making them less suitable for imminently dying patients
• A subcutaneous injection of scopolamine can be administered when the patch is applied or if management of secretions is inadequate 1

From the FDA Drug Label

PRECAUTIONS General Scopolamine should be used with caution in patients with pyloric obstruction or urinary bladder neck obstruction. Transderm Scōp should be used with caution in the elderly or in individuals with impaired liver or kidney functions because of the increased likelihood of CNS effects. Caution should be exercised in patients with a history of seizures or psychosis, since scopolamine can potentially aggravate both disorders Information for Patients Since scopolamine can cause temporary dilation of the pupils and blurred vision if it comes in contact with the eyes, patients should be strongly advised to wash their hands thoroughly with soap and water immediately after handling the patch. Patients should be advised to remove the patch immediately and promptly contact a physician in the unlikely event that they experience symptoms of acute narrow-angle glaucoma (pain and reddening of the eyes, accompanied by dilated pupils). Patients who expect to participate in underwater sports should be cautioned regarding the potentially disorienting effects of scopolamine. DOSAGE AND ADMINISTRATION Initiation of Therapy: To prevent the nausea and vomiting associated with motion sickness, one Transderm Scōp patch (programmed to deliver approximately 1. 0 mg of scopolamine over 3 days) should be applied to the hairless area behind one ear at least 4 hours before the antiemetic effect is required.

The uses of scopolamine include:

• Preventing nausea and vomiting associated with motion sickness
• Preventing postoperative nausea and vomiting The precautions of scopolamine include:
• Using with caution in patients with pyloric obstruction or urinary bladder neck obstruction
• Using with caution in the elderly or in individuals with impaired liver or kidney functions
• Using with caution in patients with a history of seizures or psychosis
• Avoiding contact with the eyes
• Removing the patch immediately if symptoms of acute narrow-angle glaucoma occur
• Cautioning patients who expect to participate in underwater sports regarding the potentially disorienting effects of scopolamine 2 3

From the Research

Uses of Scopolamine

• Scopolamine is used for preventing and treating motion sickness, as it is the most effective single agent for this purpose 4, 5, 6, 7, 8
• It is also used for premedication before anesthesia and for its antiemetic effects 5
• Scopolamine has been used in conditions requiring decreased parasympathetic activity, primarily for its effect on the eye, gastrointestinal tract, heart, and salivary and bronchial secretion glands 5

Precautions of Scopolamine

• Scopolamine can cause adverse effects such as dry mouth, drowsiness, and impairment of ocular accommodation, including blurred vision and mydriasis 4, 5, 6, 8
• It can also cause adverse central nervous system (CNS) effects, difficulty in urinating, rashes, and erythema, although these are less common 4, 5, 6, 8
• Scopolamine should be administered to pregnant women only under observation, as it readily crosses the placenta 5
• The drug is compatible with nursing and is considered to be nonteratogenic 5
• Scopolamine can cause impairment of memory storage for new information, particularly with prolonged or repeated application 4, 6

Administration and Dosage

• Scopolamine can be administered via transdermal patches, tablets or capsules, oral solutions, or intravenously 4, 5, 7, 8
• The recommended dosage is a single transdermal scopolamine patch applied to the postauricular area at least 6-8 hours before the anti-motion sickness effect is required 4
• For faster protection, the patch may be applied 1 hour before the journey in combination with oral scopolamine (0.3 or 0.6 mg) 4